Ninomiya Risa, Omi Tokuya, Kato Tokue, Mayumi Nobuko, Kawarasaki Mai, Kawana Seiji
Department of Dermatology, Nippon Medical School.
J Nippon Med Sch. 2014;81(1):48-52. doi: 10.1272/jnms.81.48.
A 61-year-old man was admitted to our department with purpura and hemorrhagic bullae on his lower limbs, dull pain affecting the entire abdomen, and hematochezia. Histopathological examination and immunostaining revealed leukocytoclastic vasculitis of the small blood vessels of the dermis and IgA deposition; multiple ulcers were observed in the ileum during lower gastrointestinal (GI) endoscopy, so we made a diagnosis of IgA vasculitis (Henoch-Schönlein). Treatment with oral prednisolone (PSL) at a dose of 80 mg/day (1 mg/kg/day) for one week resolved the symptoms almost completely. However, when the PSL dose was later reduced, dull epigastric pain and discomfort flared up again. Multiple punched-out ulcers were observed in the duodenum during upper GI endoscopy, and immunostaining revealed cytomegalovirus (CMV) in vascular endothelial cells and infiltrating cells. The patient's serum was positive for CMV antigenemia. On the basis of these findings, we concluded that the CMV enteritis had developed as a complication arising from the patient's immunosuppressed state, which was itself a result of the steroid therapy. We treated the patient with ganciclovir, which relieved the abdominal symptoms.
一名61岁男性因双下肢紫癜和出血性大疱、全腹钝痛及便血入院。组织病理学检查和免疫染色显示真皮小血管白细胞破碎性血管炎及IgA沉积；下消化道内镜检查时在回肠发现多处溃疡，因此我们诊断为IgA血管炎（亨诺-许兰型）。给予口服泼尼松龙（PSL）80mg/天（1mg/kg/天）治疗1周后症状几乎完全缓解。然而，后来PSL剂量减少时，上腹部钝痛和不适再次发作。上消化道内镜检查时在十二指肠发现多处圆形溃疡，免疫染色显示血管内皮细胞和浸润细胞中有巨细胞病毒（CMV）。患者血清CMV抗原血症呈阳性。基于这些发现，我们得出结论，CMV肠炎是由于患者因类固醇治疗而处于免疫抑制状态引发的并发症。我们用更昔洛韦治疗该患者，腹部症状得到缓解。
